OWHA Health Screening Questionnaire U18 (North Simcoe Girls Hockey Association)
Print
OWHA Health Screening Questionnaire U18
This questionnaire must be completed by each individual prior to participation in each on-ice or off-ice activity. This questionnaire may be completed verbally.
Questions
The answer to all questions must be “No” in order to participate in each on-ice activity. 1. Are you experiencing any of these symptoms?
Do you have a fever? (Feeling hot to the touch, a temperature of 37.8C or higher)
*
No
Yes
Chills
*
No
Yes
Cough that’s new or worsening (continuous, more than usual)
*
No
Yes
Barking cough, making a whistling noise when breathing (croup)
*
No
Yes
Shortness of breath (out of breath, unable to breathe deeply)
*
No
Yes
Sore throat
*
No
Yes
Difficulty swallowing
*
No
Yes
Runny nose, sneezing or nasal congestion (not related to seasonal allergies or other known causes or conditions)
*
No
Yes
Lost sense of taste or smell
*
No
Yes
Pink eye (conjunctivitis)
*
No
Yes
Headache that’s unusual or long lasting
*
No
Yes
Digestive issues (nausea/vomiting, diarrhea, stomach pain)
*
No
Yes
Muscle aches
*
No
Yes
Extreme tiredness that is unusual (fatigue, lack of energy)
*
No
Yes
Falling down often
*
No
Yes
For young children and infants: sluggishness or lack of appetite
*
No
Yes
Remaining questions
For the remaining questions, close physical contact means: Being less than 2 meters away in the same room, workspace, or area for over 15 minutes or living in the same home.
In the last 14 days, have you been in close physical contact with someone who tested positive for COVID-19?
*
No
Yes
In the last 14 days, have you been in close physical contact with a person who either: Is currently sick with a new cough, fever, or difficulty breathing; OR Returned from outside of Canada in the last 2 weeks?
*
No
Yes
Have you travelled outside of Canada in the last 14 days?
*
No
Yes
Your name
*
Date
*
RadDatePicker
RadDatePicker
Open the calendar popup.
Calendar
Title and navigation
Title and navigation
<<
<
January 2021
>
<<
January 2021
S
M
T
W
T
F
S
53
27
28
29
30
31
1
2
2
3
4
5
6
7
8
9
3
10
11
12
13
14
15
16
4
17
18
19
20
21
22
23
5
24
25
26
27
28
29
30
6
31
1
2
3
4
5
6
Human Validation
Check The Box
*
Human Validation Failed, Please Try Again
Team Sites
U7
U7
U9/U11
U9/U11 Group 1
U9/U11 Group 2
U9/U11 Group 3
U9/U11 Group 4
U9/U11 Penguins
U9/U11 Hurricanes
U9/U11 Canucks
U9/U11 Panthers
U13
U13 Group A
U13 Group B
U13 Ducks
U13 Knights
U13 Kings
U13 Sharks
U15
U15 Group A
U15 Group B
U15 Group C
U15 Group D
U15 Panthers
U15 Lightning
U15 Avalanche
U18
U18
U18 Rangers
U18 Islanders
O18
NSGHA development skates
View All
Our Sponsors
Social Networking
Follow Us On
- and -
Quick Links
Manage Subscriptions
Signup to receive
email
or
text messages
for the teams you want to follow.
Login
Sitemap
Help
Contact
Search
Rss
Tue Jan 26, 2021
Recent Results
North Simcoe Girls Hockey Association
Home
Covid-19 Resources
Fill out right before EVERY single visit
NSSRC Questionnaire
OWHA Health Screening Questionnaires
U7 OWHA Health Screening Questionnaire
U9/U11 Group A OWHA Health Screening Questionnaire
U9/U11 Group B OWHA Health Screening Questionnaire
U13 Group A OWHA Health Screening Questionnaire
U13 Group B OWHA Health Screening Questionnaire
U15 Group A OWHA Health Screening Questionnaire
U15 Group B OWHA Health Screening Questionnaire
U18 OWHA Health Screening Questionnaire
O18 (Senior team) OWHA Health Screening Questionnaire
Penetang arena-Covid-19 Screening Tool
Coldwater development COVID forms
Coldwater Covid Waiver (print and sign before every visit)
Screening Form for Coaches fill out and email 2 hrs before
CDCC Guidelines
Covid Arena Floor Plan
Fill out ONE time only
NSSRC Rules and Restrictions document (to read)
NSSRC Waiver (fill out once)
NSGHA Response Protocol COVID-19 (to read)
Penetang arena-Covid-19 Facility and Programs Waiver
OWHA Session Tracking Sheet (for coaches only)
About Us
Mission & Vision
NSGHA Bylaws
NSGHA Constitution
NSGHA Policies & Procedures
Executive & Staff
Current Coaches
Our Sponsors
Contact Us
Games Centre
Schedule & Results
Organization Calendar
Game Officials Portal
Registration
General Information
Tryout Schedule
NSGHA Resources
Criminal Offence Declaration form (print, fill out and forward to
[email protected]
)
Rowan's Law: Concussion Awareness
Links
Classifieds
My Calendar
Share
Feedback
You Are Here:
Organization Home
» OWHA Health Screening Questionnaire U18
Printed from nsgha.com on Tuesday, January 26, 2021 at 11:36 PM
Social Bookmarks
(What's This?)